Let’s talk about the important
aspects of bipolar disorder.
Starting with defining it.
is a mood disorder
and it’s characterized
by episodes of mania,
hypomania, and also major depression.
There are a lot of different
types of bipolar disorder.
So let’s consider bipolar I, this is
defined by at least one manic episode
and it's often accompanied by
depressed or hypomanic periods.
Bipolar type II is marked by
at least one hypomanic episode
and at least one major
And there are absolutely no manic
episodes associated with bipolar type II.
There can be mixed episodes,
which is when depressed mood
coexists with manic symptoms.
Patients here meet criteria
for both depressive
and manic episodes at the same exact time.
There can also be rapid cycling.
Rapid cycling is the alternating
periods of hypomanic periods
with mild to moderate depressive symptoms
intermixed over the course of two years.
Bipolar disorder epidemiology is important.
It’s estimated that the lifetime
prevalence among adults worldwide is 1-3%,
making it a fairly common disorder.
The mean age of onset for bipolar
type I is about 18 years old
and for bipolar
type II, it’s 20.
It equally affects men and
women with a ratio of 1:1
and patients will often present first
in their primary care settings,
not to the psychiatrist.
Here’s a question for you,
what percentage of individuals with
a history of one manic episode
will go on to have
another manic episode?
The answer there is 90%
and this of note if they’re not
getting treatment for their bipolar.
So unmanaged illness is
going to have a very high
And people are particular
susceptible to having mania
during times when their
sleep becomes imbalanced.
So especially when somebody travels,
maybe changes time zones
or if for some reason, they
need to stay up at night,
maybe they’re now working the night
shift or something of this sort.
Bipolar disorder tends
to be underdiagnosed
and it’s often misdiagnosed especially
in ethnic minorities as schizophrenia.
The differential diagnosis of
bipolar disorder is broad.
And like every psychiatric disorder,
it is imperative that you rule out general
medical conditions that can mimic bipolar.
So here’s a list of a few medical conditions
that you really do need to rule out
before labelling somebody with
a psychiatric mood disorder.
These are neurological disorders,
things like epilepsy or seizures,
especially of the temporal
lobe, multiple sclerosis,
and cerebral tumors.
Also, metabolic problems like
hypothyroid, Cushing’s syndrome,
neoplasms, HIV infection, and systemic
disorders like B12 deficiency,
carcinoid syndrome and uremia.
Just like every major
we must also rule out that the symptoms are
produced by a substance or medication.
So here are a few common
substances or medications
that can actually mimic bipolar disorder.
Steroids, sympathomimetics; bronchodilators,
people use commonly for asthma;
this is an important note.
So antidepressants can actually
unmask a manic episode
in somebody who’s at all
susceptible for having one.
Also, anything that increases dopamine
and any kind of alpha agonists
can also mimic bipolar disorder.
This is a nice chart where you can
look at the various types of bipolar
and put it into some
So we think if euthymia is
our kind of steady state,
how we normally are, and usually there
are some ups and downs within that.
However, bipolar is when
things become more extreme,
the highs become really high
and the lows get really low.
And so with bipolar I,
that looks like mania.
Bipolar II, not quite mania, less
severe episodes we call hypomania,
but more depressed episodes and
cyclothymia of course being that
rapid shifting within
a two-year period.